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NPI Code Detail

MEDICARE: ANGELYNN MAIRE GRABAU MSN RN CNP

MEDICARE: ANGELYNN MAIRE GRABAU MSN RN CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerR1368783MN

General Provider Information

NPI Number : 1417999871
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELYNN MAIRE GRABAU MSN RN CNP
Provider Business Mailing Address
First Line : P.O. BOX 209036
Second Line : SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
City : DALLAS
State : TX
Zip : 75320-9036
Country : US
Telephone Number : 813-281-8478
Fax Number : 813-281-8113
Provider Business Practice Location Address
First Line : 2025 E RIVER PARKWAY
Second Line : SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
City : MINNEAPOLIS
State : MN
Zip : 55414-3604
Country : US
Telephone Number : 612-596-6191
Fax Number : 612-339-7634
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 03/29/2011

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